Healthcare Provider Details

I. General information

NPI: 1861559528
Provider Name (Legal Business Name): JOHN J. WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

PO BOX 326
FRANKLIN LAKES NJ
07417-0326
US

V. Phone/Fax

Practice location:
  • Phone: 609-429-0054
  • Fax:
Mailing address:
  • Phone: 609-429-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number192403
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06319000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: